| NPI | 1982773909 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JIMMY TODD GEAN Pharmacist 731-632-0995 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 454) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2021-01-05 |